An external evaluation of a peer-run outreach-based syringe exchange in Vancouver, Canada

Objective: Vancouver, Canada has been the site of an epidemic of human immunodeficiency virus (HIV) among injection drug users (IDU). In response, the Vancouver Area Network of Drug Users (VANDU) initiated a peer-run outreach-based syringe exchange programme (SEP) called the Alley Patrol. We conducted an external evaluation of this programme, using data obtained from the Vancouver Injection Drug Users Study (VIDUS). Methods: Using generalised estimating equations (GEE) we examined the prevalence and correlates of use of the SEP among VIDUS participants followed from 1 December 2000 to 30 November 2003. Results: Of 854 IDU, 233 (27.3%) participants reported use of the SEP during the study period. In multivariate GEE analyses, service use was positively associated with living in unstable housing (Adjusted Odds Ratio [AOR] = 1.83, 95% Confidence Interval [CI]: 1.39 – 2.40), daily heroin injection (AOR = 1.31, 95% CI: 1.01 – 1.70), daily cocaine injection (AOR = 1.34, 95% CI: 1.03 – 1.73), injecting in public (AOR = 3.07, 95% CI: 2.32 – 4.06), and negatively associated with needle reuse (AOR = 0.65, 95% CI: 0.46 – 0.92). Conclusion: The VANDU Alley Patrol SEP succeeded in reaching a group of IDU at heightened risk for adverse health outcomes. Importantly, access to this service was associated with lower levels of needle reuse. This form of peer-based SEP may extend the reach of HIV prevention programmes by contacting IDU traditionally underserved by conventional syringe exchange programmes.